What causes ADHD? Some intriguing findings
January 11th, 2008 by David E. Williams of the Health business blog

A short paper in the current issue of the Journal of Child Neurology (Hypokalemic Sensory Overstimulation) raises some tantalizing possibilities:

* In some patients, ADHD may be caused by an excess of sensory stimulation arriving at the brain, rather than being a disorder of the brain itself
* For such patients, potassium supplements may be an effective treatment
* ADHD symptoms may indeed be triggered by sugar in some people
* ADHD and PMS may be related in some women –and their PMS may also be treatable with potassium
* Dentists may be well-positioned to identify possible ADHD patients

Conventional wisdom is that attention deficit disorder results from a problem in the brain. This seems reasonable since the stimulants used to treat ADHD work on particular pathways in the brain. But conventional wisdom is not getting much traction: researchers have studied the genes in these dopamine pathways and found only weak effects on ADHD.

Now, a group of Harvard-associated doctors –including Health Business Blog contributor Michael Segal MD PhD– has suggested a different model for ADHD based on an excess of sensory stimulation arriving at the brain. They came up with this model by stumbling across a family with some peculiar issues, and by having the background to understand the importance of what the patients were describing. Interestingly, they were able to treat the ADHD with a simple over the counter medication - potassium supplements.

The authors were not originally focused on ADHD. They were drawn into the area when a woman described to a neurologist that one of the core features of ADHD, a sense of being bombarded by sensory input, suddenly went away, “as if a shade had been pulled down.” This occurred 20 minutes after she took an oral potassium supplement for muscle cramps.

The neurologist was intrigued. It reminded him of the muscle disease hypokalemic periodic paralysis, in which ion channels in muscle become over-active when potassium levels in the blood are low. The woman described the factors that triggered her symptoms, and they were the same as those noted in the muscle disease: meals high in carbohydrates, food high in salt, and resting after exercise. Her son, who was having attention problems in school, also found the same triggers and got the same benefit from taking potassium.

Hypokalemic periodic paralysis is part of a family of “channelopathies.” Other variants were known in the heart (producing arrhythmias), in the brain (producing seizures), and in sensory nerves (producing pain). No variants producing ADHD had been described, and it would be difficult to suggest a channelopathy producing ADHD since the evidence in this family seemed “soft” –based as it was on subjective patient reports.

That all changed one day. The boy got a shot of the local anesthetic lidocaine for minor toe surgery, but he insisted that the numbing medicine wasn’t taking effect, even after repeated shots. The surgeon was skeptical but touched the boy’s toe lightly with his instruments and was surprised when the boy could describe exactly where he touched. The doctors knew that lidocaine works on sodium channels, and realized that an insensitivity to lidocaine would fit very well with a channelopathy causing sensory overstimulation. When the mother heard the details later that day she recounted that lidocaine hardly worked for her in dental procedures. Now the doctors had some objective evidence suggesting a channelopathy accounting for the core symptom in ADHD.

The way to confirm such a hypothesis is to find the gene for the mutant ion channel, which is hard to do using a small family. The doctors knew that it would take more families to do “positional cloning” to find the gene, and wrote up their paper, hoping to find other families. The paper appeared in early January and within days of publication another family sent an email to the contact address on the paper to describe a similar story in their family. If you have a story like that you may also want to make contact using the email address listed here.

Until the gene is found it is hard to say whether this sensory overstimulation form of ADHD is common or rare. Some factors suggest this clinical picture may be common - some people with ADHD think their symptoms are worse after consuming sugar, and occupational therapists describe a “sensory integration disorder” in many people with ADHD. One intriguing line in the paper even suggests that the sensory overstimulation may show up in ways that might not have seemed connected at all to ADHD: the mother “suffered for many years from strong menstrual pelvic cramping and noticed in her mid-40s that oral potassium supplementation blunted the menstrual pain to a dramatic degree.”

As people become familiar with the sensory overstimulation model of ADHD and researchers do the genetics we may soon have an understanding of ADHD at the molecular level and have new forms of treatment and prevention.

I've used potassium supplements in the past, but I can't say they've ever have done anything for ADD for me.

Interestingly, coffee has quite a bit of potassium in it. Quite a few of us are attracted fo coffee (I know I am), though I'm pretty sure that this isn't the reason why.

__________________Disclaimer: none of the posts on this forum should be taken as medical advice. Optimally, always seek the opinion of multiple experienced professionals, note any discrepancies, and use your best judgment, as well as research, to determine what is true, untrue, and neither (opinion).

wow, very very very interesting. Dentist numbing agents never worked on me either, did I ever learn that when I needed 4 teeth pulled in one visit and I felt it clear as day with two numbings.... and indeed, one of my main problems is too much damn stimulation.

I've always loved bananas, I can eat a whole bunch at a time and awesome stuff happens...hmmm...Im going to buy some potassium suppliments right now! cya

wow, very very very interesting. Dentist numbing agents never worked on me either, did I ever learn that when I needed 4 teeth pulled in one visit and I felt it clear as day with two numbings.... and indeed, one of my main problems is too much damn stimulation.

I've always loved bananas, I can eat a whole bunch at a time and awesome stuff happens...hmmm...Im going to buy some potassium suppliments right now! cya

People should consult a doctor before trying the potassium pills; the doses are in the published paper. While bananas have a fair amount of potassium, the amounts are small compared to the pills. Potassium supplements are used often, hence they've been sold for years over-the-counter in drug stores, but they can be a problem in people with certain medical conditions.

It is thought that people with this ADHD variant and those with the muscle disease "hypokalemic periodic paralysis" don't have potassium levels that are lower than those in other people; rather it is known that everyone's potassium level fluctuates and people with these conditions are particularly sensitive to these otherwise normal fluctuations, and have low-ish potassium levels when most symptomatic.

It is not clear what fraction of ADHD will be accounted for by the variant described in this paper; the fraction is not necessarily low; it is just unknown at this early point. People who have the lidocaine insensitivity are encouraged to contact the authors (see contact info in the original post). It should be relatively easy to pull out the gene based on analysis of several families. A second family was found a few days after the paper appeared, and with a few families there can be rapid progress in finding a gene. Once the first gene is found it becomes much easier to find the other genes, allowing diagnosis and treatment of ADHD to become a lot more scientific.

Both patients described in the paper find that caffeine-like substances (coffee, chocolate etc.) are helpful. Although caffeine may produce some potassium changes it also has stimulant effects. So one should not assume that caffeine having a beneficial effect tells us much about whether someone has this variant or another variant of ADHD.

Also, one should not assume that the boundaries or even the separateness of ADHD, Asperger syndrome, and sensory integration disorder are well understood. As we begin to understand the genes involved we may find that some of these classifications are similar to the proverbial blind men describing an elephant. Finding the genes is key to sorting out this whole area.

Did I make it clear that the squashed and crushed bananas were not destined for smoothies -
- or roughies (or coughies) -
as I phlegmatically insist they should no be called ?

-*-

Tamms
- your link is interesting

K of potassium from kalaemia deriving from 'alkali' -

acid + base -> salt + water

... ... salty oceans make for wicked demonstrations of electrolysis.

Aren't acids usually red in text books and all alkaline bases covered in a kinda' blue -?-
thinking magnets and baby clothes

(if I see another pink baby dress -
oh my!:-)
)

alkaline poles o->
(stop sniggering)

and acidic poles o+ too

(Are men from Poland
- as opposed to Mars ...?...*)

* Tentatively suggested and meant to be forgotten shortly after the chortles fade.

and

Quote:

Originally Posted by Stabile

small changes in brain chemistry

underlying ADD.

-*-

Quote:

Originally Posted by Nova,Stabile

No such thing as a free particle

Placing us at the interface of proton acceptance and donation - characterizing the acid - base relationship -
and ith the suggestion -
since the proton is not a particle which exists all on its lonesome -
that our world may oe rather some to

n <just less="" than="">< 9
~that is~
8 -> O

and (H)2 + O -> water.

Water as a kinda' bridge between physics and chemistry.

-*-

Is it just me -
or does the K - rich list look rather like the Fe - rich list too ?

(Fe was covered extensively previously here on ADDF (someplace))

So -
K and Fe associating within the same foodstuffs -?-
with K bearing a name derived from 'alkaline'.

-*-

Iron rapidly oxidizes - and is not found as regular Fe - but instead is found in complex with O(xygen) on planet 'so pretty' -
- were it not for yellow fruits and vegetables including :

Apparently I am sleep reading but maybe I can get it straight this time - are you saying that people who do not get numb when injected with lidocaine should contact the authors - what if they aren't hyperactive - neither my mother nor I respond to Novocaine. While it doesn't make us numb it does tend to cause a slight nausea - when they used it for dental purposes - I am hyperactive and she is not even diagnosed with ADD - we both squash bananas on occasion but not because we don't like them but because squashing squishy things is fun - okay I do that my mother well who knows -

We both have muscle cramps in strange places, like our toes . . .

I have always felt my hyperactivity was due to a filtering value problem - in that I can not filter out in coming stimuli.

So I believe this idea may be worth at least hearing out and perhaps if necessary helping out - if parameters are met that is{bananas traveling from Texas all the way up to Boston my get rather rank in the nares - I would think} . I mean at least these guys are looking to ADDers to find the cause of ADD and based upon the paper I read these people may actually be trying to listen to us - I have to say this is an improvement worthy of a bit of respect {IMHO} At least this isn't another frontal lobe approach - that one was getting boring.

Is it just me -
or does the K - rich list look rather like the Fe - rich list too ?

If it is you then you are probably right - been down that road before - your writing is different but that hardly equates being wrong. I am good with chemistry stuff but you are much better at it than I am - we must have gone to the same parties or some thing.

besides if we avoid the bananas and citrus fruits that leaves chocolate fish nuts - to be read with a comma between each word naturally. . . . but I couldn't resist the ADD made me do it Think I will build another Reese's pieces pyramid on my desk. . . . will help me make more sense? probably not but it will taste good none the less.

Oh and I like cats - better than bananas - plus they don't itch as much as citrus fruits.

oh the translation - I agree the list has many of the same foods as the iron one does and acid does tend to have some thing to do with our ability to concentrate - if any thing the itching from normal amounts of consumption makes sitting still almost impossible - over reaction from citric acids are some thing a few of us share potassium being alkaline- hopefull that will help with the dot connection.

Quote:

K of potassium from kalaemia deriving from 'alkali' -

acid + base -> salt + water

... ... salty oceans make for wicked demonstrations of electrolysis

Haven't considered this before but it does make sense. Oh I am supposed to be translating I almost forgot . . .

Therefore we are talking about acid base balances and potassium iron and can't forget sodium, chloride,bicarbonate patterns, with the effects in diet and ADD which is directly related to the potassium ADD topic - as electrolytes are the way impulses travel - so this is an important consideration - this translation is given just in case some one thinks we are getting off topic.

Apparently I am sleep reading but maybe I can get it straight this time - are you saying that people who do not get numb when injected with lidocaine should contact the authors - what if they aren't hyperactive - neither my mother nor I respond to Novocaine. While it doesn't make us numb it does tend to cause a slight nausea - when they used it for dental purposes - I am hyperactive and she is not even diagnosed with ADD - we both squash bananas on occasion but not because we don't like them but because squashing squishy things is fun - okay I do that my mother well who knows -

We both have muscle cramps in strange places, like our toes . . .

I have always felt my hyperactivity was due to a filtering value problem - in that I can not filter out in coming stimuli.

So I believe this idea may be worth at least hearing out and perhaps if necessary helping out - if parameters are met that is... I mean at least these guys are looking to ADDers to find the cause of ADD and based upon the paper I read these people may actually be trying to listen to us ...

The genetics folks are interested in finding the gene. At this stage we are trying to create a "registry" to get a wider sense of the clinical picture in the type of ADD described in the initial family. The strategy is to focus on this particular variant in the hope of having a homogeneous group for which one might find a single gene through "positional cloning". The geneticists have experience in doing these things at a distance. The chief difficulty will be the likelihood that there are many different genes for ADD.

A female not having an ADD diagnosis is not necessarily an exclusion. Most people diagnosed with ADD are males, despite the fact that ADD is thought to have an "autosomal dominant" form of inheritance in which there are typically equal numbers of males and females. The general presumption is that females are as likely to have the gene but somehow better at masking the problem, particularly the hyperactivity. By focusing on the inattention or sensory overload symptoms, experts in ADD say they get an equal sex ratio.

Once one finds a gene, one can get a much better sense of how it is expressed in the population. The usual outcome is that one finds the variation is much wider than one would predict from the very typical people chosen for the phase in which the gene is first identified. Also, one develops a detailed picture of disease variant such that in the future a workup for ADD could include questions that would rarely be asked today - about such things as dentist visits, menstrual pain, use of sunglasses and episodes of limb weakness.

I've seen this process of identifying genes applied to study of epilepsy, migraines and other areas of medicine and it would be real progress to be able to do the same with ADD, particularly since many with ADD, often females, are treated as if their problems are not real.